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CHICAGO—The Homeland War in Croatia, which occurred from 1991 to 1995, led to an increase in weapon-related deaths of children during and five years after the end of the war, according to a report in the February issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.

"After World War II until the beginning of the Homeland War in 1991, most children in Croatia were not exposed to firearms and explosives in their homes or communities," the authors write as background information in the article. "Unlike many countries, personal weapon ownership was not a custom in Croatia." This changed as the Homeland War—also called the Third Balkan War—moved into Croatian land. Citizens began purchasing grenades, firearms and other weapons on the black market or taking them from military barracks after the Yugoslav army left Croatia. The population remained overly militarized in the wake of the war; in 2007, 371,684 weapons were legally owned by Croatians.

Aida Mujkic, M.D., of the University of Iowa, Iowa City, and colleagues studied Croatian children from birth through age 19 who died of weapon-related injuries between 1986 and 2005. Statistics were obtained from Croatia’s national vital statistics system and included traumatic injury deaths classified by intent, including homicide, suicide and unintentional categories.

Compared with the period before the war, rates of homicide and suicide with weapons more than tripled during the war—from .22 to .73 homicides and .51 to 1.64 suicides per 100,000 children. Unintentional weapon-related deaths also increased by more than six-fold, from .25 to 1.63 per 100,000 children.

"These increases persisted for five years following the end of the war and decreased more than five years after the war," the authors write. Weapons-related deaths in the early postwar period—1996 to 2000—remained more than twice as high as before the war, and the weapon-related suicide rate remained more than three times that of the pre-war period. Homicide and unintentional injury deaths decreased significantly in the late post-war period, 2001 to 2005, and suicide rates were the same as in the pre-war period. The number of children who died from causes other than weapons did not change over the course of the study.

"Programs that focus on the prevention of weapon-related injuries should be integrated into programs that assist countries in rebuilding after political unrest," the authors conclude. "The combination of psychological effects of war on children with an increased presence of weapons may present a particularly important area for prevention."
(Arch Pediatr Adolesc Med. 2008;162[2]:140-144.)

Editor's Note: This study was supported by an NIH grant from the University of Iowa/Fogarty International Traumatic Injury Training Program. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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